Children’s mental health: the challenge ahead for the NHS, councils and schools

This weeks’ publication of the Mental Health Five Year Forward View by NHS England has prompted much debate about how far we can get to real equality for mental health in the NHS over the next five years.

Nowhere is the challenge greater than in improving the mental health and life chances of children and young people. Childhood mental health problems are common, persistent and serious. We know they affect one child in ten at any time, rising to one in five by the time a young person reaches early adulthood.

Yet evidence from international studies shows that it typically takes ten years for a young person to get any help, from the time they first show the signs of a mental health difficulty to the time they get support. And in those ten years, for many young people problems escalate, accumulate and too often come to a head in a crisis.

There are numerous reasons for this ten year delay in getting help. Confusion and poor understanding about what is happening when their mental health takes a downward turn accounts for the greater part of this decade-long delay in getting help. Teenagers also feel stigma of mental ill health keenly - frequently avoiding seeking help because of shame and embarrassment.

Even when assistance is actively sought, help often remains elusive or involves lengthy delays. Most parents of children with a mental health difficulty ask for help (predominantly asking their children’s schools or GPs), but the majority receive no support. Families consistently report that it is like ‘negotiating a maze’ to get any help from local services. They also say that they find help to be overly formal and not ‘youth-friendly’. And whilst young people may look for assistance from friends or online, they worry about the quality of advice they are accessing.

We also know that both mental health support in general, and children’s mental health in particular, are chronically under-funded. Early help (particularly important in preventing children drifting into damaging crises) has been particularly badly hit by funding pressures on local councils. Young people say they want more focus on understanding mental health in schools. However, many teachers, faced with broader national curriculum priorities, feel poorly resourced and ill equipped to help children and young people build their mental health literacy and access support when needed.

The Mental Health Taskforce report sets out some big ambitions for the next five years. And it comes with extra investment, including funds specifically for children and young people’s mental health. In return for that investment, local areas have been asked to produce ‘transformation plans’ for children’s mental health that bring together local councils, health services and schools.

It is crucial that in all local areas, there is a clear and sustained focus on reducing the ten-year gap in getting help to children and young people who need it. That means improving both the quantity and quality of mental health support to children and young people, listening to what they find helpful and redesigning services accordingly. It means reaching out much more and building mental health literacy in families and schools, giving every school the know-how to do their part to protect and promote children’s wellbeing. And it means focusing particularly on offering better help to groups of children and young people who face the biggest risks and whose needs are most often ignored.

This week, the BBC’s In the Mind campaign has once again shown how important it is to support children’s mental health. The taskforce report has generated new hope that more young people will have access to better, faster help. It is vital that the report’s recommendations are put into practice across the country, with clear lines of accountability for achieving results. Children’s mental health is too important to be left to chance.

Risk, Safety and Recovery argues that risk and safety are rightly major concerns in mental health care but that traditional clinical management methods of assessing risk have stood in the way of helping people to recover their lives.

Perinatal mental health problems carry a total cost to society of about £8.1 billion for each one-year cohort of births in the UK. But the NHS would need to spend just £337 million a year to bring perinatal mental health care up to the recommended level.